Provider Demographics
NPI:1770512964
Name:DELTA COUNTY HEALTH DEPT
Entity Type:Organization
Organization Name:DELTA COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:HORN
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-2167
Mailing Address - Street 1:255 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1626
Mailing Address - Country:US
Mailing Address - Phone:970-874-2165
Mailing Address - Fax:970-874-2175
Practice Address - Street 1:255 W 6TH ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1626
Practice Address - Country:US
Practice Address - Phone:970-874-2165
Practice Address - Fax:970-874-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04540225Medicaid
CO04540225Medicaid
CO804953Medicare UPIN
COC804953Medicare Oscar/Certification